Harmless Kidney Markets

Written by Adam Shriver


Kidney transplants result in improved quality of life and increased longevity compared to dialysis for patients with end-stage renal disease (Evans et al. 1985, Schnuelle et al. 1998, Wolfe et al 1999).  In 2014, the national transplant list in the United States passed a milestone of 100,000 people waiting for kidneys.  However, the current rate of kidney donations, both from living and deceased donors, is not high enough to keep up with demand (Becker & Elias 2007). As a result, many people die each year and the quality of life of many more people is significantly diminished.

In response to this problem, various authors have proposed the creation of a regulated market for kidneys whereupon individuals may sell one of their kidneys in exchange for money and possibly other benefits (Matas et al. 2008, Gaston et al. 2006, Radcliffe-Richards et al. 1998, Radcliffe-Richards 2012, Veatch 2003).  Kidney sellers could be paid relatively large amounts of money (~$95,000) while maintaining a cost-effective system due to the savings obtained from moving people off dialysis (Matas 2008).  If implemented, a regulated kidney market could result in important increases in quality of life and in survival rates.

I admit I find the arguments from authors such as Matas and Radcliffe-Richards largely persuasive.  Nevertheless, their proposals have been subject to a number of criticisms from ethicists that pull on strong moral intuitions.  In what follows, I present an alternative model for a kidney market that I believe avoids the most serious objections to kidney markets.  In contrast to previous arguments that suggest that the benefits of regulated kidney markets would outweigh the harms, I will propose a model that is harmless, on the best way of understanding a harmful practice.  If, as I argue, we can design a kidney market where the decision to give up a kidney does not harm the seller, this suggests that we can reap the benefits of a kidney market without the ethical costs that have raised concerns. Continue reading

Where There is Life, There is Not Always Hope. Ethics, Futility and the Alfie Evans Case

by Dominic Wilkinson


[Updated 22/02/18]

This afternoon, in another case of disputed medical treatment for a seriously ill child, Justice Hayden in the High Court concluded that treatment should be withdrawn from toddler Alfie Evans against the wishes of his parents.

See below for a press release on the Alfie Evans decision. I will add further reports and links to the court transcript when it is available.

See here for ethics commentary and resources on the Charlie Gard case.

See also my recent blog on the Evans and Haastrup cases: Medical treatment disputes and the international second opinion

Details from the court ruling (Liverpool Echo)

Court judgement

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Cross Post: The Discomforts of Being a Utilitarian

Written by Hazen Zohny 

Please note that this essay was originally published in Quillette Magazine.


The Discomforts of Being a Utilitarian 

I recently answered the nine questions that make up The Oxford Utilitarianism Scale. My result: “You are very utilitarian! You might be Peter Singer.”

This provoked a complacent smile followed by a quick look around to ensure that nobody else had seen this result on my monitor. After all, outright utilitarians still risk being thought of as profoundly disturbed, or at least deeply misguided. It’s easy to see why: according to my answers, there are at least some (highly unusual) circumstances where I would support the torture of an innocent person or the mass deployment of political oppression.

Choosing the most utilitarian responses to these scenarios involves great discomfort. It is like being placed on a debating team and asked to defend a position you abhor. The idea of actually torturing individuals or oppressing dissent evokes a sense of disgust in me – and yet the scenarios in these dilemmas compel me not only to say such acts are permissible, they’re obligatory. Biting bullets is almost always uncomfortable, which goes a long way in explaining the lack of popularity utilitarianism enjoys. But this discomfort largely melts away once we recognize three caveats relevant to the Oxford Utilitarianism Scale and to moral dilemmas more generally.

The first of these relates to the somewhat misleading nature of these dilemmas. They are set up to appear as though you are being asked to imagine just one thing, like torturing someone to prevent a bomb going off, or killing a healthy patient to save five others. In reality, they are asking two things of you: imagining the scenario at hand, and imaging yourself to be a fundamentally different being – specifically, a being that is able to know with certainty the consequences of its actions.

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Medical Treatment Disputes and the International Second Opinion

By Dominic Wilkinson



Disputes about medical treatment for seriously ill children are in the news again. Last week, the High Court in London decided in favour of withdrawal of life support from a brain damaged 11-month old infant, Isaiah Haastrup, against the wishes of his parents (an appeal is pending later this month). This week, the High court, sitting in Liverpool, is hearing evidence in the case of 20-month-old Alfie Evans, an infant with an undiagnosed degenerative brain condition.

In both of these cases, as in the controversial Charlie Gard case from last year, medical evidence from UK professionals has been overwhelmingly in favour of withdrawing life support and allowing the children to die. However, in each case parents have sought and have obtained evidence from overseas medical specialists who have testified in favour of continued treatment. In the Evans case, as in the earlier Gard case, experts from the Vatican hospital in Rome have apparently offered ongoing treatment.

This suggests several questions. First, why is there a difference between the views of specialists in this country and those overseas? Second, if there are differences in expert opinion about treatment for a child, should courts give any more weight to the views of UK experts than those from overseas? Is there a valid reason to discount the international second opinion?

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How Utilitarian Are You? Measure on The Oxford Utilitarianism Scale

Blog Authors: Julian Savulescu, Brian D. Earp, Jim A.C. Everett, Nadira Faber, and Guy Kahane

This blog reports on the paper, Kahane G, Everett J, Earp BD, Caviola L,  Faber N, Crockett MJ, Savulescu J, Beyond Sacrificial Harm: A Two Dimensional Model of Utilitarian Decision-Making, Psychological Review [open access]

How Utilitarian are you? Answer these 9 questions to find out…

If you enjoyed taking our ‘How Utilitarian Are You?’ test,  read our new blog post discussing how we developed it, what it shows, and why it’s important

Utilitarianism is one of the oldest and most influential theories about what the right thing to do is. It says that the right act is the one which has the best consequences. In the first formulation by Jeremy Bentham, hedonistic utilitarianism, the right act is the one which maximises happiness and minimises suffering. Richard Hare and Peter Singer made preference utilitarianism famous: the right act is the one which maximises satisfaction of preferences.

Utilitarianism was a novel egalitarian theory when it was developed in the 1700s. It was a radical departure from authoritarian, aristocratic or otherwise hierarchical ways of thinking, positing that each person’s happiness and suffering was to count the same. In stark contrast to the social norms of the day, utilitarianism held that the happiness of the pauper is just as important as the happiness of the Prince or the Pope.

Utilitarianism has fallen into disrepute. It is now equated with Machiavellianism: the end justifies the means, whatever those ends may be. It is also seen as coldly calculating, or else simplistically pragmatic. The German philosopher Friedrich Nietzsche described it as a morality appropriate for shop keepers. Recently it has even been portrayed a doctrine for psychopaths. Pope Paul II put it succinctly in 1995:

“Utilitarianism is a civilization of production and of use, a civilization of ‘things’ and not of ‘persons,’ a civilization in which persons are used in the same way as things are used.”

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In Defence of Impulsivity

Written by Dr Rebecca Brown

It has become commonplace to identify a lack of impulse control as a major cause of poor health. A popular theory within behavioural science tells us that our behaviour is regulated via two systems: the fast, impulsive system 1 (the ‘impulsive’ or ‘automatic’ system) and the slower, deliberative system 2 (the ‘reflective’ system). Much of our behaviour is routine and repeated in similar ways in similar contexts: making coffee in the morning, travelling to work, checking our email. Such behaviours develop into habits, and we are able to successfully perform them with minimal conscious input and cognitive effort. This is because they come under the control of our impulsive system.

Habits have become a focus of health promoters. It seems that many of these routine, repeated behaviours actually have a significant impact on our health over a lifetime: what we eat and drink and how active we are can affect our risk of developing chronic diseases like type II diabetes, heart disease, lung disease and cancer. Despite considerable efforts to educate people as to the risks of eating too much, exercising to little, smoking and drinking, many people continue to engage in such unhealthy habits. One reason for this, it is proposed, is people’s limited ability to exert conscious (reflective) control over their habitual (impulsive) behaviour.

Given this, one might think that it would be preferable if people were generally able to exhibit more reflective control; that behaviour was less frequently determined by impulsive processes and more frequently determined by reflective deliberation. Perhaps this could form part of the basis for advising people to be more ‘mindful’ in their everyday activities, such as eating, and regimes for training one’s willpower ‘muscle’ to ensure confident conscious control over one’s behaviour. Continue reading

Video Series: John Harris Defends Gene-Editing in Human Embryos

Novel gene editing technologies, such as CRISPR/Cas9, allow scientists to make very precise changes in the genome of human embryos. This could prevent serious genetic diseases in future children. But the use of gene editing in human embryos also raises questions: Is it safe? Should prospective parents be free to choose the genetic characteristics of their children? What if they want to use gene editing to have a deaf child, or a child with fair skin and blue eyes? Should gene editing be regulated globally, or should each country have their own legislation? In this interview with Katrien Devolder, John Harris (Professor Emeritus, University of Manchester &  Visiting Professor in Bioethics, King’s College London) answers these and other questions, and defends the view that we have the strongest moral obligation to gene-edit human embryos, not only to prevent disease but also for the purpose of enhancement.

Pedophilia and Child Sexual Abuse Are Two Different Things — Confusing Them is Harmful to Children

By Brian D. Earp (@briandavidearp)

Republican politician Roy Moore has been accused of initiating sexual contact with a 14-year-old girl when he was in his early 30s. Social media sites have since exploded with comments like these:

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Video Series: Should We Pay People to Quit Smoking or Lose Weight?

Should we pay people to quit smoking or lose weight? Would paying them amount to coercion?  Is there a risk that if we start paying for healthy behaviour, its value will be corrupted? Is paying unhealthy people unfair to those who already lead healthy life styles? In this video interview (with Katrien Devolder),  Dr Rebecca Brown from the Oxford Uehiro Centre for Practical Ethics responds to these and other concerns and defends the use of financial incentives as a tool for health promotion.

Blade Runner 2049, Parfit and Identity

Julian Savulescu


Contains spoilers for both Blade Runner films. This is a longer version of a shorter piece without spoilers, Blade Runner 2049: Identity, Humanity, and Discrimination, in Pursuit 

Blade Runner 2049, like the original, is about identity, humanity and discrimination.

Identity and Humanity

In both films, bioengineered humans are known as replicants.  Blade Runners “retire” or kill these replicants when they are a threat to society. In the original, Blade Runner Rick Deckard (Harrison Ford) has all the memories and feelings of a human and believes himself to be a human, only at the end to discover he is a replicant. In the sequel, K (Ryan Gosling) is a replicant but comes to believe (falsely) that he is Deckard’s child. In Blade Runner 2049, we are left to watch K dying, realising his memories were implanted by Deckard’s daughter.

In both films we are left wondering what difference there is between a human and a replicant. In the original, rogue replicant Roy Batty (Rutger Hauer) saves Deckard’s life (as Deckard was trying to kill him) and delivers famous “Tears in the Rain” speech:

“I’ve seen things you people wouldn’t believe. Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhäuser Gate. All those moments will be lost in time, like tears in rain. Time to die.”

Roy comes across as more human than the humans in the film. Indeed, in a preceding scene, a thorn or spike appears through his hand reminiscent of Christ, whose own identity as fully human and fully divine has puzzled Theologians for two millenia.

Both films challenge what it is to be human. In 2049, K believes the child of Deckard might have a soul because it was born.

Who are we?

The films both raise fundamental questions about personal identity: who are we? What fundamentally defines the existence of a person from one moment to the next? In both films, there is the suggestion that the biological mass, the body, is not what matters but the mind. In the original, bioengineered Roy seems as human as Deckard, as human as someone could be. In 2049, the idea is extended further still: K’s girlfriend Joi is an AI but seems as real as the other characters and her death is equally tragic.

Derek Parfit died in January this year. He was the world’s most famous moral philosopher (and his favourite film was another Ridley Scott classic, The Duellists). One of his famous ideas is that “identity” is not what matters. He articulated this in his masterpiece, Reasons and Persons (Oxford: Clarendon Press, 1984). According to Parfit, what matters is psychological continuity and connectedness, that is, the unity of our mental states.

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